Outpatient Parotidectomies Associated with Lower Complication Rates Than Inpatient Parotidectomies

What impact do parotidectomies have on postoperative complications compared to inpatient procedures?

Bottom line
Outpatient parotidectomies are associated with similar as well as decreased complication rates as compared with inpatient parotidectomies. 

Background: More than 90% of procedures of the ear, nose, mouth, or pharynx, were reported to the American Hospital Association as same-day procedures. However, strict criteria for patient selection and discharge are imperative due to the risk of procedure-specific adverse events, cardiac and pulmonary compromise, and other postoperative complications, and literature establishing outpatient parotidectomy safety is insufficient.

Study design: Retrospective analysis of parotidectomies 4,368 superficial or total parotidectomies performed between 2005 and 2014 (1,453 inpatient, 2,915 outpatient).

Setting: National Surgical Quality Improvement Program database.

Synopsis: The inpatient cohort had significantly greater number of patients in older age groups than the outpatient cohort, and was more male. The outpatient cohort had a higher number of white patients. Higher prevalence of dyspnea, smoking, previous percutaneous coronary intervention, hypertension, transient ischemic attack, disseminated cancer, bleeding disorders, systemic sepsis, emergency, dependent functional status, and greater ASA American Society of Anesthesiology class (3 and 4) were significantly associated with the inpatient cohort. To account for patients undergoing multiple procedures, total work relative value units (RVUs) were contrasted between cohorts. Inpatient procedures were associated with larger total work RVUs and longer operative times than outpatient procedures. The most common cause for parotidectomy among cohorts was neoplasm (76.5% inpatient, 75.4% outpatient). Other causes included a swelling, mass, or lump (9.9%), sialadenitis (2.5%), and mucocele (1.8%). Higher rates of surgical and medical complications were associated with the inpatient cohort, specifically a greater prevalence of pneumonia. Researchers found no difference in readmission or reoperation frequency between cohorts. The most common procedures performed were incision and drainage of a hematoma, seroma, or fluid collection. Limitations included potential procedure miscoding and variations in inpatient/outpatient case difficulty and complexity.

Citation: Siddiqui SH, Singh R, Siddiqui E, et. al. Outpatient versus inpatient parotidectomy: comparison of postoperative complication rates. Laryngoscope. 2019;129:655–661.